Evaluation of the red cell distribution width as a biomarker of early mortality in hepatocellular carcinoma

Abstract Background The red cell distribution width is a biomarker of early mortality across various disease states. Aim To verify whether it may refine estimates of survival in hepatocellular carcinoma. Methods The red cell distribution width measured at diagnosis was analyzed in relationship to mortality by any cause both in a retrospective training cohort ( N  = 208), and in an independent prospectively collected validation cohort ( N  = 106) of patients with hepatocellular carcinoma. Based on Cox proportional hazards modelling, a prognostic index was validated. Results In the training and the validation cohort, median survival time was respectively 1026 and 868 days in patients with red cell distribution width ≤14.6%, vs. 282 and 340 days in patients with red cell distribution width >14.6%; the corresponding hazard ratios were 0.43 (95% CI: 0.31–0.60), p p p C  = 0.769). Conclusions The red cell distribution width is a novel, reproducible, prospectively validated predictor of survival in patients with hepatocellular carcinoma.